Effectiveness of structured, hospital-based, nurse-led atrial fibrillation clinics: a comparison between a real-world population and a clinical trial population

Abstract

ObjectiveA previous randomised trial showed that structured, nurse-led atrial fibrillation (AF) care is superior to conventional AF care, although further research is needed to determine the outcomes of such care in a real-world setting. We compared the outcomes of patients in real-world, nurse-led, structured hospital AF clinics with the outcomes of a randomised trial of the efficacy of a nurse-led AF clinic, with respect to a composite outcome of cardiovascular-related hospitalisation and death.MethodsAll patients were referred to the AF nurse specialist by cardiologists. The AF nurse specialist provided patient education, risk-factor control and stimulated empowerment and compliance. During follow-up, treatment was adjusted according to clinical guidelines. Patient education was repeated, and compliance with medical treatment was controlled. The study size was powered as a non-inferiority study. Outcome measures were adjudicated by the same principles in both cohorts.ResultsA total of 596 patients from the real world and 356 patients from a clinical trial were included in this study. No significant difference between groups with respect to age, type of AF or CHA2DS2VASc score was found. The composite primary end point occurred with an incidence rate of 8.0 (95% CI 6.1 to 10.4) per 100 person-years in the real-world population and 8.3 (95% CI 6.3 to 10.9) per 100 person-years in the clinical trial, with a crude HR of 0.83 (95% CI 0.56 to 1.23).ConclusionsStructured, nurse-led, hospital-based AF care appears to be effective, and patient outcomes in an actual, hospital-based, structured AF care are as least as good as those in trial settings.

Regional collaboration to improve atrial fibrillation care: Preliminary data from the Netherlands heart network

“…The positive influence of the outpatient AF clinic, as presented in this study is comparable with prior research regarding outpatient AF clinics assessed in a clinical trial (academic) setting and in a real‐world setting . Although, these prior studies reported more hospitalizations (48 and 50), more major bleedings (6 and 5), higher mortality rates, and a higher number of serious adverse effects of medication, the difference in measurement periods should be taken into account. While the AF‐NET study presented 6 months follow‐up data, the results in the study of Hendriks et.al (2012) were indicated after 22 months and in the study of Qvist et.al (2016) after 14 months of follow‐up.…”

“…Therefore, no conclusion can be drawn regarding significant improvements over longer time periods. Despite significant differences in follow‐up periods, the procedure and positive influence of the outpatient AF clinic on AF‐patients outcomes as demonstrated in this study are comparable with previous studies . Nevertheless, future research should put effort in analyzing the patient relevant outcomes at 12 and 24 months, or comparing follow‐up data with similar retrospective data.…”

“…The outline of the AF‐NET study is shown by the flowchart in Figure . In prior research nurses made decisions regarding AF care themselves, leading to an essential different process than the AF‐NET study.…”

“…Optimal treatment with less cardiovascular events in AF care can be established when adherence to guidelines is increased, and variations in therapeutic and diagnostic trajectories are reduced. Prior research indicated that improved guideline adherence and providing extensive information to patients is an achievable target in cardiac care . More specifically, an integrated approach for AF has shown to be an effective and cost‐effective solution in the treatment of AF‐patients by introducing “nurse‐led care”.…”

Efficacy of a nurse-led lipid-lowering secondary prevention intervention in patients hospitalized for ischemic heart disease: A pilot randomized controlled trial

“…[11][12][13] Studies suggest that specialized post-discharge follow-up by trained nurses represents an opportunity to improve the care and outcomes of patients with cardiovascular diseases. [14][15][16] Nurses may have more availability than physicians to conduct close follow-up, and may communicate with patients more effectively, particularly in terms of health education.…”